From the Foundation for Health Services Research, Central Hospital of
Akershus, Norway.
Correspondence to Ole Morten Rønning, Department of Neurology, Central Hospital of Akershus, 1474 Nordbyhagen, Norway. E-mail bguldvog{at}sia.pilot.akershus-f.kommune.no
Background and Purpose—Organized
acute stroke treatment reduces mortality, functional deficits, and the
need of institutionalization after stroke. It is largely unknown
whether the effects of treatment are due to early or subacute
efforts. The aim of this randomized, controlled study was to test the
hypothesis that rehabilitation of stroke patients in the subacute
phase in a hospital rehabilitation unit is beneficial in reducing death
and dependency and increasing health-related quality of life.
Methods—251 patients initially treated in the hospital were
randomized to subacute rehabilitation in a hospital rehabilitation
unit (n=127) or to the health services in the municipality (n=124) and
were followed up for 7 months.
Results—The combined outcome of patients being dead or dependent
(Barthel Index score of <75) was 23% in the hospital group and 38%
in the municipality group (P=.01). Seven-month survival
rates were 90.6% and 83.9% (P=.11), respectively.
Dependency in activities of daily living was 12.6% in the hospital
group and 25.0% in the municipality group (P=.07).
Patients with a BI score of <50 before rehabilitation had
significantly better outcome in the hospital rehabilitation unit, with
fewer patients becoming dependent (P=.005) and patients
having higher Scandinavian Stroke Scale (P=.026) and BI
scores (P=.005). No significant differences in
health-related quality of life were found. Many patients treated in the
municipalities (30%) did not receive any organized rehabilitation in
this study.
Conclusions—Subacute rehabilitation of stroke patients in a
hospital-based rehabilitation unit improves outcome. Patients with
moderate or severe stroke appear to benefit most.
© 1998 American Heart Association, Inc.
Original Contributions
Outcome of Subacute Stroke Rehabilitation
A Randomized Controlled Trial
Key Words: rehabilitation • stroke management • stroke outcome
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